PwC SMART Alternatives

AZZLY Rize is the premier clinical and business platform for addiction treatment and mental health organizations. As an all-in-one substance use disorder and mental health specific EHR, Patient Engagement and RCM platform, we serve small, medium, and large clinics. Key features for OUTPATIENT Programs include: scheduling, appointment reminder, Zoom telehealth, treatment plans, progress notes, assessments and surveys. For RESIDENTIAL programs: census, medication management, bed board, withdrawal management, DrFirst e-prescribing, EPCS, PDMP, labs. For all levels of care: alerts, patient engagement portal, electronic billing and claims submission built in. AZZLY Rize empowers your staff through its 5 star training and support services, its simplicity and automation. As a true all-in-one EHR/PM/RCM platform, improved compliance, workflow and accurate billing are achieved real-time. We proudly serve programs in over 33 states and are hosted in Microsoft Azure's private cloud network.

Ensure faster, more accurate mortgage and loan document processing automation with Parascript software; automate insurance document-based tasks for the intake and review of healthcare insurance data. Optimize health plan process efficiencies, increase data accuracy and reduce costs through document processing automation. Parascript software, driven by data science and powered by machine learning, configures and optimizes itself to automate simple and complex document-oriented tasks such as document classification, document separation, and data entry for payments, lending, and AP/AR processes. Every year, over 100 billion documents involved in banking, government, and insurance are processed by Parascript software.

Virtual Examiner®, PCG Software’s flagship product, monitors the internal claims process of an organization to trend provider data for fraudulent and abusive billing patterns, and maximizes financial recoveries. PCG Software’s Virtual Examiner® allows healthcare organizations to enhance their current claims adjudication system with more than 31 million edits per claim. The software solution monitors an organization’s internal claims process to identify unclean claims and reduce payment for improper or erroneous coding to conserve premium dollars. Virtual Examiner® is more than a claims review solution with a focus on code combinations. It is a cost containment solution that evaluates the claim not only for abusive billing patterns but also identifies those claims that may involve third-party liability/coordination of benefits, case management opportunities, physician billing education and many other cost recovery reports.

Daisee builds technology to provide access to deep insight into the behavioural and emotional dynamics of your customers with the most accurate AI-powered, fully-automated AQM available for more impactful coaching, improved commercial outcomes and compliance monitoring. Daisee analyzes and automatically scores 100% of customer interactions using a world-first automated, digital quality scorecard. This automatically surfaces quality assurance issues that require human intervention in the areas of communication, compliance and conduct. Daisee enables you to see far beyond words alone, surfacing the underlying emotion hidden deep within your interactions – what your customers are really saying, thinking, and feeling. Daisee helps organisations create practical business value immediately, with software that is incredibly flexible and easy to deploy across any telephony system. Globally Daisee operates in Australia, New Zealand and the USA.

The Acrometis flagship claims processing solution offers unparalleled workflow management, with documents automatically routed by a configurable rules engine. Based around claim assessment scoring, body part to claim compensability matching, jurisdictional directives, relatedness scoring and a host of other claim elements the Acrometis business rules are designed to reduce claim duration and costs. CLAIMExpert automatically processes 65 percent of incoming medical bills and non-medical documents with no user intervention. Documents requiring adjuster intervention are flagged and sorted for easy review and straightforward decision making. Automatically processes incoming documents with NO adjuster intervention. Clients typically see between 11 and 23 points medical loss improvement in the first year. CLAIMExpert contains rules for over 190 different document types, quickly handling whitemail and any other documents that come across your adjuster’s desk.

Streamline Your Complete Healthcare Data Workflow. Smart Data Solutions has the tools and experience needed to streamline both your paper and electronic workflows. Our integrated validation, matching, and normalization tools ensure the highest quality data possible, increasing auto-adjudication and reducing manual processing. Whether you’re new to Smart Data Solutions or a long time partner, our development process helps guide you through projects to ensure the best possible position for overall success. Whether your needs are basic or complex, our staff will work with you to understand your needs and the impacts of your workflows. We believe in focusing on your goals, what you want to accomplish, and from that, identifying the best way to get there. Smart Data Solutions provides complete front-end pre-adjudication solutions for hundreds of Payers nationwide. Whether you need basic services or a completely custom workflow, Smart Data Solutions offers a variety of solutions.

Remove time and complexity from document processing while supporting straight-through processing efforts. Shift Claims Document Decisions is an AI-powered solution that analyzes documents for relevant details and creates a contextual view of action items required to move the claim forward. Our models are specifically trained with insurance documents in mind, allowing them to process forms with accuracy matching or surpassing that of an experienced human claims adjuster. Automatically evaluate documents against available data to create a complete picture of each claim and accelerate processing. Industry-specific AI continually learns to combine claims data with document details to deliver claims document decisions that drive impact. Minimize manual reviews, identify complexity, and direct handlers to claims details requiring action. We are 100% focused on insurance and hire the industry’s best talent to provide our customers with unmatched support.

ClaimBook enables faster settlement of insurance claims, improved accountability and fewer rejections. It is well equipped with the features to address every part of the claims and evidence submission. ClaimBook supports international patient treatment with dedicated workflows, therefore enabling medical tourism. A built-in Rules Engine that disallows incomplete submissions, and knows what information and documents need to be submitted. This results in error-free submissions that are complete and guarantees that it is pre-authorized. ClaimBook's Smart Data Extraction can read documents uploaded to extract relevant data from the Hospital's Information System (if integrated with ClaimBook) to prevent the need for manual entries. ClaimBook also features Integrated Emailing by creating a virtual inbox in your dashboard. Withing the dashboard, emails can be composed, the design feature is similar to Microsoft Outlook.

I-CAPS is an Intelligent Claims Administration System that addresses all functional areas of the health claims payment environment with a single common architecture that spans the needs of payers including membership, billing, enrollment, mailroom, claims, network management, contracting, pricing, utilization review and customer service. Our Intelligent Claims Administration System (I-CAPS) and our coding compliance software (Advanced Value Scale-AVS) , support knowledge-based decision-making to help our clients contain costs. Guaranteeing the integrity of Provider information has never been easier with (Advanced Network Administrator-ANA) while our (RB-UCR) is the industry's first Resource-Based, Usual Customary, and RESPONSIBLE fee schedule based on RBRVS and NCCI. Need a check-up for your plan or provider, use Cost Containment Audit and Recovery Services (CCARS) for a completely noninvasive audit retrospective look at claims effectiveness.

Accelerate your value-based initiatives by quickly analyzing and understanding episode costs. Build provider adoption and engagement with data-driven, evidence-based discussions about total episode costs and individual provider practice patterns. Drive cost and quality improvements by targeting variations in care delivery and provider performance. Empower value-based strategies through analytics, providing insights to help guide network optimization and clinical transformation. Identify value-based care opportunities through an analysis of episode costs, leveraging clinically validated episode definitions. Target providers to engage in value-based discussions through an analysis of utilization, costs, and care variations. Leverage episode analytics to help optimize network designs, transform clinical guidelines, and improve consumer engagement. Streamline episode budget creation by defining average episode costs and associated clinical services.

Automate the end-to-end claims journey, from intimation of the first notice of loss and fraud detection to claims adjudication, and finally claims settlement. Experience the flexibility of addressing various claim types differently, like death and maturity claims, while improving regulatory compliance and eliminating non-compliant penalties. Enable faster, accurate, and effective processing through data capture, payment tracking, salvage and recovery tracking, legal matter processing, monitoring, and more. Effective registration, adjudication, tracking, and management of claim submissions. Built-in, comprehensive business rules for automatically categorizing claims as “fast track” or “non-fast track”. Flexibility to add or modify stakeholders— garages, assessors, loss adjusters, surveyors, investigators, claim officers, etc.

The most widely deployed patient safety platform. Comprehensive patient safety software that helps drive lasting change and performance improvement across your organization. A global community of patient safety experts. When you join RLDatix you’re connecting with a worldwide community of patient safety changemakers. Get proven best practices and inspirational ideas from RLDatix customers, industry and thought leaders. RL Suite Comprehensive patient safety solutions to support your safety and healthcare quality initiatives. Reduce and mitigate risk by turning your data into actionable intelligence for today and tomorrow. Intervene early and keep patients safe by identifying clinical risks and reducing infections. Engage patients in real-time to ensure they receive the best possible experience. Centralize policies and procedures to drive institutional learning and compliance.

Claim Leader develops and provides technology solutions to automate the communications and workflow processes across the business enterprises of insurance claims organizations. Our software solutions allow to simplify your operations, while providing superior productivity through an advanced, and integrated web platform. Feature-rich modules within Claim Leader systems create a simplified workflow for internal administrators and on the field users. Management tools allow internal users to dispatch assignments to field staff, sort workload, pinpoint files for review, and streamline workflow.

An analytics-driven claims and remittance management solution for healthcare providers who want to automate workflows, improve resource utilization, prevent denials, and accelerate cash flow. Increase your first pass claim acceptance rate. Our comprehensive edits package helps you stay current with changing payer rules and regulations. Heighten your staff’s productivity with intuitive, exception-based workflows and automated tasks. Your staff can access our flexible, cloud-based technology from any computer. Manage your secondary claims volume through automatic generation of secondary claims and explanation of benefits (EOB) from the primary remittance advice. Focus on claims that need your attention with predictive artificial intelligence into problem claims. Resolve errors faster, and avoid denials before submittal. Process claims more efficiently. Print and deliver primary paper claims, or add collated claims and EOBs for secondary claims.

Protect the integrity of your health plan and determine accurate pricing with the Context4 Health Plans Suite, our modular, cloud‑based technology platform. Immediate, actionable, and defensible Fraud, Waste, and Abuse (FWA) detection built by our team of certified clinical, dental, and health benefits experts. Accurate data and cutting-edge cloud technology combine to create a proven and defensible medicare reference-based pricing (RBP) solution. More than 100 healthcare data sets, with professional support to optimize efficiency and compliance. Advanced medical coding software designed to expedite claim submission and minimize denials. Our cloud based Payment Integrity Platform utilizes our proprietary analytics engine to identify coding errors, medical necessity, unbundling, fraud-waste-abuse, audit risks, pricing and other aberrations that can impact your business.

LMS enables efficient trading and management of residential whole loans. You can monitor the entire loan pipeline, handle third-party reviews, and fund/settle loans on a streamlined, automated basis. Sellers can lock and price loans on a flow or bulk basis that fit your product’s eligibility guidelines through our portal. They can upload credit documents and satisfy conditions raised during reviews. Securely upload and store credit documents at a trade, pool, and loan level. Exchange documents with third-party vendors through secure integrations. Direct orders to appropriate diligence vendors based on product & volume. View & resolve third-party reviewer’s results using automated vendor data feeds. Generate funding schedules with amortized balances, calculated interest and fees.

Quadient® Correspondence, manage claims correspondence, in the cloud. Quadient® Correspondence is a subscription-based SaaS solution that enables insurers to create, approve and deliver regulatory compliant, accurate and personalized claims correspondence to customers across print and digital channels, with no reliance upon IT. Quadient Correspondence was designed and priced for insurers who want to further their transformation to digital, but don’t have the resources to invest in an end-to-end customer communications management (CCM) solution. Business analysts create and update templates. Claims managers and compliance experts edit & approve templates for use. Business users write correspondence using a controlled editing experience. Designated personnel review and approve correspondence for delivery. Instant delivery via email, PDF and SMS. Business users start by selecting the appropriate claims correspondence template and customizing the content within pre-defined editable fields.

PayorLink solutions offer more than just medical claims management on behalf of employers to take on a comprehensive platform approach in providing better employee benefits to reduce healthcare costs, promote healthy lifestyle, lifetime health and improve workforce productivity in the process. Rising employee health costs is a worldwide phenomenon and a growing concern for both payor companies and provider entities alike. PayorLink™ is designed to reduce payor health cost, motivate staff productivity and optimize provider claims quality resulting from in part, information exchange efficiencies directly between payor companies and affiliate provider clinic, medical centre or hospital. Enhanced with Employee Health Profile and Assessment tools for staff wellness and productivity realization.

This product is an end to end claims system. The primary functions are claims adjudication, claim workflow and payment disbursement. The flexible design allows the addition of adjudication modules on a line of business basis. Each new line of business added reuses the core functionality of the system. This system takes advantage of the user friendly windows screen design and makes use of a relational database to store information within the system. The software platform is Powerbuilder with an SQL database such as Oracle or Sybase. This combination of software supports a client server based environment that is capable of processing large volumes of claims. Installation and training are available and source code is included as part of the licence fee. Expert staff is available for customizations and tailoring of the system to meet any special requirements identified by the client. All modifications are available with detail design and support for acceptance testing.

Meet the challenges of value based care—no matter your current EHR. Get a clear view into your patient population with aggregated multi-source data and an easy-to-navigate visual display. Use insights based in data to better manage chronic conditions and care transitions, prevent illness, lower costs, and implement care management. Facilitate care coordination with tools that encourage a proactive approach, including a pre-visit dashboard, risk stratification, and automated tracking of admission, discharge, and transfer events. Put care management in operation. Extend physician reach. Foster critical interactions with patients and valuable follow-up in between appointments. Identify patients with the greatest risk for high-cost utilization, using the Johns Hopkins ACG system for risk stratification. Accurately assign resources where intervention is needed most. Improve performance on quality measures. Participate successfully in value-based payment programs and optimize reimbursement.

FBCS Enterprise is a centralized system for guiding decisions about non-VA Purchased care to improve fee basis claims management and adjudication through efficient claims processing. A web-based solution, CTM Plus streamlines workflows and provides oversight to resolve consult and Return to Clinic (RTC) tracking pain points, and ensure patients are called and scheduled on time. Purchasing analytics help to reduce cost and waste, for greater overall accountability. Expired and recalled items are also monitored automatically to keep patients safer. Delayed or misplaced orders can have significant consequences for your bottom line and quality of care. Time spent sorting through paper records and scrolling through screens is time you won’t have for patients. Checking every patient for opioid prescriptions can be an exhausting, multi-step process. DSS PDMP streamlines everything into one simple step.

HealthRules® Payor is a next-generation core administrative processing system that provides transformational capabilities to health plans of all types and sizes. For more than ten years, health plans implementing HealthRules Payor have been able to quickly address market opportunities and stay in front of their competition. HealthRules Payor is unlike any other core administrative solution because of its use of the patented HealthRules Language™, an English-like vernacular that delivers a revolutionary new approach to configuration, claims processing and transparency of information. HealthRules Payor helps transform health plans looking to grow, innovate and compete beyond any other core system today.

Optimize and automate your processes without writing a line of code by harnessing the power of low-code. You can utilize the array of functional building blocks within LEAP to create custom and flexible applications that will enable you to automate your processes. Apply your processes to one of our pre-configured industry solutions. With the majority of the configuration already in place, your LEAP solution can be created in days by our analysts – and even demonstrated so that you can see it in action. By joining together functional building blocks your solution is built in weeks, not months – leaving you with a high-quality solution, at a lower risk and cost. An impressive array of functions and features can deliver the outcomes you need, providing you with a solution that is right for your organization. Pay for usage, not users. Activity-based, rather than user-based licensing means you only pay for what you use. Plus setup costs are kept to a minimum.

Claims Adjudication for medical, dental, vision, prescription, short and long-term disability claims. Available for on-site license or as a hosted application (ASP). Microsoft technology: SQLServer database with a Windows front end. Acclaimed Customer service staffed by health care claims experts with a minimum of 12 years’ experience in the field. Support calls are logged with status available via the internet. Plan copy and modification feature enable quick setup of plans. Auto-adjudication using benefit codes built using business rules based on over 25 variables from both the claim and the claimant records made available to the adjudication engine. Inbound claims can be scanned images, EDI or paper. HIPPA EDI 5010 transaction sets. Re-pricing fee and UCR Schedules can be loaded on the system in advance of the effective date. The date-driven logic will re-price based on the date of service.

The market's most powerful and accurate solution for claims processing. CyberSource Medical Claims Scanning Solution, a complete turn key system for HMO, PPO, TPA, or Self Funded Organization, is installed at your location for automated data entry of CMS-1500, ADA-2006 UB-04 and enrollment forms. Using advanced "intelligent" features combined with your business rules, CyberSource recognizes, validates and formats the data from medical claim forms. Fuzzy Matching performs an intelligent search of your member and provider database correctly identifying the exact match. The matched data is then utilized to verify and correct data on the medical claim before being passed through to adjudication. The combination of industry-leading OCR efficiency, your business rules and “Fuzzy Matching” results in exceptional accuracy of the data from your medical claims forms.

HoudiniEsq is an advanced, browser-based law practice management for today's modern law firms. Available in the cloud or on premise, HoudiniEsq offers a robust feature set that enables law firms to streamline workflows, capture and classify all types of documents, automate billing, task scheduling, and group calendaring, and more. The platform also integrates with solutions such as LawPay, Microsoft Office, Outlook, Evernote, QuickBooks, Acrobat, Calendar/Court Rules, WordPerfect, and Google Suite.

In insurance, no interaction has a greater long-term business impact than a claim. It’s the moment of truth for insurers and policyholders. ClaimsXPress maximizes insurers’ opportunities to deliver distinctive experiences that drive positive results. Claims service is a major differentiator for insurers, no matter the market. ClaimsXPress helps insurers enhance the claims experience, earn customers’ loyalty and drive more business from distribution channel partners. Nimble companies know they can grow faster with efficient processes and systems that are able to scale. ClaimsXPress is designed with insurers’ growth in mind. Speed is valuable, in claims response and access to data. ClaimsXPress is a top performer in both areas, enabling users to accelerate their objectives.

Claims Manager is a comprehensive, integrated RIMS system built to streamline your process from FNOL to settlement. A unique, configurable business rules engine automates workflow, reduces manual and duplicate work, saves time, and improves outcomes for all stakeholders. Claims Manager’s integrated solutions streamline workflow by helping you administer, adjust, and report your property and casualty claims. Claims Manager is a versatile, and simple to use Risk Management Information System that offers tomorrow’s solutions, today. Its intuitive interface seamlessly integrates with an automated workflow that is accessible anytime, anywhere, from any device. Letting you easily capture, benchmark, administer, and report claims for all lines of property and casualty insurance.

Driving breakthrough clinical and administrative results. Evolent Care Partners, Midwest health system ranked third in the nation for both total shared savings and percentage of savings off of benchmark. Evolent Care Partners enables independent primary care physicians with the capital and resources needed to participate and succeed within two-sided payer contracts, while limiting their financial risk. New Century Health delivers cost and quality improvements in oncology and cardiology by using clinical evidence to guide care decisions that are supported by both payers and providers. Evolent Health Services simplifies health plan operations through comprehensive services that are powered by a modern and integrated platform, and a true strategic partnership model. Explore insights and news on value-based care, population health, health plan administration and other health care transformation topics.

W5 Claims Management Software - Managing your claims, understanding and growing your business. How many things do you and your staff do every day over and over? Get this, do that, repeat. It’s not just about saving time on repetitive tasks. It’s about making sure they don’t get missed when you have a long list of to do’s that need doing now. - Automation Documents, thousands and thousands of documents and photos. Getting them, organizing them, securing them, distributing them. It’s a big job and critical to your success. - Document Management Time constraints and customer SLA’s. It’s not enough that you need to meet those challenges but you have to measure and report your successes and failures. So how well do your adjusters perform? Where and what are the potholes that trip up your staff? Can you show your customers that their trust is well placed? - Workflow + Business Intelligence Analytics

CoreLogic modernizes the global property & casualty insurance industry with flexible, collaborative and secure claims estimate technologies. We create world-class experiences that simplify business and improve lives. Claims Connect™ from CoreLogic® streamlines the claims process for everyone involved through an integrated digital ecosystem. Transform your workflow so your customer’s claims are resolved efficiently and more accurately. All your information is securely stored in one platform and accessible by everyone working on the claim. No more switching between different software to edit and review claim information. Create estimates or make changes within Claims Connect and it automatically syncs so that everyone can see the changes instantly. Keeping everyone involved in the claims process up to date with the information they need, when they need it, will make your claims resolutions simpler, faster, and more efficient.

Automation is one of the primary growth drivers towards increased profitability, and the demand to automate workflows across accounts payables (AP) has witnessed significant growth - across small to large Enterprises. Usher in zero-touch invoice processing with Kanverse. Ingest, extract, validate, and publish without manual interventions. Reduce cycle time, increase efficiency, reduce invoice processing errors, meet global compliance standards, and save costs. Traditional OCR solutions required process owners to create multiple templates to capture data from different invoices. Kanverse APIA uses AI-powered OCR to read invoices, eliminating the need to develop templates for extraction and the painful template creation process. Kanverse's AI-powered Accounts Payable Invoice Automation reduces invoice documents processing cycle time, increases organizational productivity, reduces document processing errors, and meets all end-to-end compliance and security requirements.

Mercury by Quick Silver Systems allows Automobile, Property, and Casualty insurance carriers to easily rate, quote, bind, make payments, and report claims online. Minimize customer service calls through online document access, bill payments, and first notice of loss. Modular API based system allows seamless integration with new or existing data providers. Fully digital document production and 100% web-based system works on any device. Create custom, event-driven work-flows with our visual work-flow designer. Access the most up-to-date information on Written, Earned, and Unearned premiums. Automatically save every page, card, report, email, and more to review and share with associates. Collect currency in any digital format including: ACH, EFT, Electronic Checks, Credit, or Bank Card. Information Technology within an insurance company not only needs a system that provides wide accessibility.

Winning and satisfying today's empowered consumers means having the right process foundations for your digital business. Fadata’s connected software solutions keep you ahead of the game. Insurers today are looking for the right digital business foundations, including the flexibility to respond quickly to new business opportunities, easy connectivity and other capabilities to help them stay ahead of the competition. Fadata’s insurance process platform, INSIS, is the most advanced and comprehensive solution available across all major lines of business. INSIS helps you release products more rapidly, drive engagement with your customers and partners, make processes faster and more efficient, and strengthen operational control and compliance. Capabilities are integrated on a single, highly flexible platform.

ScanNStore is a full-featured electronic document storage and retrieval system in a small package. It's the perfect solution for increasing productivity by electronically organizing and managing paper files. ScanNStore lets you and your staff quickly scan, index, store and retrieve your claims, attachments, remittance notices, and other documents. You can search by multiple indexes and display claims and all related information on-screen, as if you are looking at the original paper. Where instant access to the right claim information is critical, ScanNStore is the right solution. Contact us to download and try out a fully functional multi-user version of ScanNStore for 30 days. Volume seat licensing and vendor discounts available. Supports a wide variety of TWAIN scanners and production level scanners including HP, Fujitsu, Ricoh, Bell & Howell and Panasonic. Supports single page or multi-page batch scanning, automated document feeder, page size, contrast adjustment, etc.

The FACTS® family of products supports multiple lines of business within a single information system: Health, Indemnity, TPA, PPO, HMO, PHO, IPA, MSO, Group Administration, COBRA, Section 125-Integrated Flexible Benefits, and Workers' Compensation with Integrated Managed Care for 24-hour coverage. From the inception of HIPAA, the FACTS® system infrastructure has been based on HIPAA-compliant solutions. FACTS® is fully committed to ensuring a clear and easy path to HIPAA readiness - well ahead of the federally mandated compliance deadlines. FACTS® fully integrated, interactive Internet and voice-based systems empower healthcare administrators and professionals with 24 x 7 access to claims and benefit information, and real-time transactions such as EDI claim uploads, through the Internet. Improve your risk and insurance management.

We offer upfront pricing with several options; monthly flat rate, per case, or a combination of both. Included at no additional charge is our Information at a Glance Dashboard, Customizable Task List, and Scheduler. This means all Case Information is available in one place without needing any additional software. Some of Teamworks IRO unique features. Simplified method to collect and maintain data for IRO, URA, Peer Review, Insurance Companies and Attorneys. At a glance, you will know what cases are due, what tasks are due, what documents are due, what payments are due, faxes and emails - System generated and easily managed. Task List - Automatically created for each new case. Reports - Case and financial reports generated by easy point and click. Case closing Report - Automatically generated and sent to the appropriate state agency.

Innovator, connector and leader for the insurance industry. We have the most extensive straight-through processing platform within the UK. Explore how our digital platform addresses your business needs. Business transformation powered by increased agility and a digital end-to-end experience. Improved productivity fueled by adviser and consumer self-service capabilities. Higher customer lifetime value through proactive ongoing engagement with customers. Customer and Adviser Portals – users access policy documentation and update personal and policy details and features digitally, in real time. Components cover every facet of the user experience including full reinsurance reporting, external portal integration, and automated and clerical underwriting. Flexible deployment – from full end-to-end SSG Digital platform deployment, to discrete integrated individual components (e.g. underwriting only, New Business only).

Five Sigma set out on a mission to allow claims organizations to innovate. With the set of claims management tools and unique platform, Five Sigma's suite is what Insurers need to bring their claims operation to the rapidly changing world. With our suite of Claims-First Cloud-Native and User-Centric products, we enable adjusters to handle claims better and faster. With Automating administrative tasks, Adjusters can focus on making the right decisions, while the system takes care of everything else. Full end-to-end suite for claims management with in-system omni-channel communication platform, automated documentation, automated workflows, reporting and open APIs. Go live in weeks with the state of the art claims management platform. With the unique SaaS offerings and agile methodology, Five Sigma's solutions are deployed in weeks instead of months and with weekly upgrades, we enable carriers to continuously improve claims operations.

TherapyNotes is an easy-to-use and feature-rich practice management software for behavioral health practitioners. It combines robust scheduling tools, patient notes, electronic billing, and a custom patient portal. The software is also certified HIPAA- and PCI-Compliant, which helps to ensure that all practice and patient records are secure and encrypted. Managing a practice comes with plenty of paperwork that can keep you out of session. With features like simple electronic claim submission and assisted ERA payment posting, you'll have fewer data entry errors and less tedious paperwork. TherapyNotes™ integrates all aspects of your practice to help you improve patient care. Person‑centered documentation, searchable diagnoses, and more time in‑session help you provide your clients with the care they deserve.

CaseGlide is driving the revolution in claims litigation management. Gone are the days of disconnected and siloed claims systems, manual and inefficient workflows, and hundreds of emails passing between defense counsel and claims teams containing unstructured case data. With CaseGlide you can focus on strategy, data, and driving efficiency to improve your litigation management program. Our clients better predict and manage their case outcomes, assign the right attorneys to the right cases, work cases more strategically, and significantly reduce their litigation costs. As your defense attorney partners work your cases in the platform, integrations allow you to push important case data to your claims system, data warehouse, document management, or accounts payable system. It’s simple: the longer a case is open, the higher your costs.

A web-based claims management solution paired with unparalleled customer support. For claims management professionals who are looking to scale and manage their business, ClaimPilot offers its web-based claims management solution that provides the ease of use, features and functionality you need to gain visibility of claim and financial information with custom reporting. Address increasing demands of data inputs required with customizable features. Increase claims processing efficiency. Unlike unwieldy, feature-loaded risk management-focused claims software or lighter software packages that focus on document management only, ClaimPilot provides the features you need to manage your claims including Lloyd’s compliance, and workers comp functionality. Plus, you get our legendary customer support. Our team of experts partners with our clients to build custom reports and functionality to support your growing business. The way we see it, if you are successful, you’ll be successful.

Next-generation medical coding & auditing with AI. Streamline your manual inpatient coding and auditing processes, improve coding and documentation quality, and unlock your team to focus on high-value work. Semantic Health drives improvement at leading hospitals. Semantic Health uses custom clinical AI and NLP algorithms, trained on millions of records by our world-class AI team, to parse through clinical and coded data which allows our coding and auditing engines to better understand nuanced clinical context, incorporate changing coding guidelines and rules, and suggest high-quality coding and auditing opportunities with clear evidence back to the clinical documentation. Save time and optimize your revenue cycle by adding AI to labor-intensive medical coding and auditing processes. Semantic Health offers hospitals and health systems a supercharged inpatient auditing platform for a 100% pre-bill review of claims data.

Nuance Performance Analytics helps improve clinical, financial and patient outcomes by providing real‑time data analytics and decision support systems for quality management, CDI leadership and patient safety teams to track, analyze and benchmark performance. Nuance Performance Analytics is a web‑based solution that incorporates the latest regulatory, payment and reporting rules to provide comprehensive, customizable options to help analyze risks and identify improvement opportunities. Data is updated daily for all criteria, not weekly or monthly. The single data source for care team members to understand all populations and performance. Identify emerging trends with a graphic representation of performance opportunities. Integrated inpatient and outpatient outcomes identify MCCs that are also HCCs. From the boardroom to the bedside, Nuance Performance Analytics enables reports to be easily customized to meet multiple stakeholders’ needs.

EXPEFLOW’s workflow intelligence unlocks the new normal of hybrid work environments, digital transformation, and “paperless processes”. Our no-code workflow intelligence frees up your employees to focus on customer engagement and growing your business! Workflows are manual, long, and error-prone processes that rely on employees to make repeated attempts to obtain missing information and key pieces of data. EXPEFLOW’s intelligent QuickStart file types increase focus on your customer experience while increasing your operational accuracy and efficiency. You are in control with our no-code platform! With our user interface, you can design your workflows without the need to wait for developers or additional resources. Engage employees and increase productivity to drive a greater customer experience! Workflows need to be flexible as customers and industries are unique. Our platform has the domain knowledge and expertise to help you work better and smarter!

The most intuitive practice management and client-centric EHR software for mental health and substance abuse treatment professionals, BirchNotes is built to help you grow and manage your practice with ease. An EHR is designed with a behavioral health therapist in mind. Features and tools chosen and tailored for both substance abuse and mental health professionals. Your EHR, billing, insurance, scheduling, and telehealth are all in one integrated solution. No need for multiple log-ins, systems, or additional tools! No matter your practice setting or size, BirchNotes offers the flexibility and scalability to meet your needs. Our workflows are insights are configured to best suit your practice. Easily manage your practice with our smart workflows, automation, and customizable settings to help save you time and focus more on what matters to you. A better solution for better outcomes. Group, telehealth, and recurring appointments are fully supported, plus customizable calendar views.

CaseworksPro is an affordable web-based claims administration system designed to support a wide range of claim processing requirements. Developed by Insurance Technology Solutions, CaseworksPro is purpose-built for carrier claims departments, self-insured retentions (SIRs) and third-party administrators (TPAs). This easy-to-use solution offers a host of features that include SIR client-centric workflows, policy data capture, one-ff and scheduled payments, user-defined access permissions, check printing, electronic reporting, and NCCI and ISO stat code capture.

Ahshay Platform by DataCare is a database of multiple software solutions for medical management. It includes medical process manager, nurse care management software, utilization review software, auto case management software and more. The platform caters to the needs of companies from insurance providers, self-insured groups, managed care, and individual nurse case managers.

This application automates the repricing of claims in a Web environment. WebCR verifies provider participation and patient coverage, validates dates of service, and identifies possible duplicate claims. It is supported by a data management team and system, WebDM, that works to ensure accuracy and currency of data. This application automates the repricing of claims in a client/server environment. WebCRX verifies provider participation and patient coverage, validates dates of service, and identifies possible duplicate claims.

Dreaming of happy, efficient claim handlers; fast, accurate claims resolution; and 5-star policyholder ratings? Our agile, future-ready platform enables your people to perform like rockstars, and equips your company with scalable, intuitive processes to fuel profitable growth. By simplifying and automating the workflow, our clients reduce the cost of the claims journey by as much as 30%. VCA Software is one of the most scalable and integration-friendly platforms in the market. Our robust features, at a mid-range price point, make us a favorite among TPAs and adjusting firms. Yes, VCA is lightning fast, but the system is also whip-smart – equipped with a cutting-edge analytics suite so you can make fact-based decisions. You can count on VCA for industry-leading uptime, privacy, and data security. Our Tier 1 data centers are located in the USA, UK, Canada, and Australia. Our solutions can be easily customized to meet your team’s unique requirements.